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Diagnostic Criteria on 18F-FDG PET/CT for Differentiating Benign from Malignant Focal Hypermetabolic Lesions of Parotid Gland

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Abstract

Purpose

We investigated PET/CT diagnostic criteria for differentiating benign from malignant parotid lesions with focal 18F-FDG uptake.

Methods

The subjects of the study were 272 patients who exhibited focal 18F-FDG uptake of the parotid gland. Sixty-eight pathologically confirmed parotid lesions from 67 patients were included. The maximum SUV (SUVmax), uptake patterns (homogeneous vs. heterogeneous), size measured by CT, maximum Hounsfield units (HUmax) and margins on CT (well vs. ill defined) of each parotid lesion on PET/CT images were compared with final diagnoses.

Results

Thirty-two parotid lesions were histologically proven to be malignant. There were significant differences in uptake patterns (cancer incidence, heterogeneous:homogeneous = 79.2%:29.5%, p < 0.0001) and margins on CT (cancer incidence, ill:well defined = 84.4%:13.3%, p < 0.0001) between benign and malignant lesions. The cancer risks of parotid lesions were 89.5% with heterogeneous uptake and ill-defined margins, 70.6% with heterogeneous uptake or ill-defined margins (no overlap in subjects) and 9.3% with homogeneous uptake and well-defined margins (p < 0.0001). When any lesion with heterogeneous uptake or ill-defined margins was regarded as malignant, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 90.6% (29/32), 80.6% (29/36), 80.6% (29/36), 90.6% (29/32) and 85.6% (58/68), respectively. For predicting malignancy, combined PET/CT criteria showed better sensitivity, NPV and accuracy than PET-only criteria, and had a tendency to have more accurate results than CT-only criteria. There were no significant differences in SUVmax, size or HUmax between benign and malignant lesions.

Conclusion

Uptake patterns and margins on CT are useful PET/CT diagnostic criteria for differentiating benign from malignant lesions.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea

    Soo Bin Park, Joon Young Choi, Eun Jeong Lee, Jang Yoo, Miju Cheon, Suk Kyong Cho, Yearn Seong Choe, Kyung-Han Lee & Byung-Tae Kim

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  1. Soo Bin Park
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Correspondence to Joon Young Choi.

Electronic supplementary material

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Supplementary Table 1

Comparisons of clinical and PET/CT findings between benign and malignant focal parotid lesions detected on 18F-FDG PET/CT in LS scanner subgroup. (DOCX 23.7 kb)

Supplementary Table 2

Comparisons of clinical and PET/CT findings between benign and malignant focal parotid lesions detected on 18F-FDG PET/CT in STe scanner subgroup. (DOCX 23 kb)

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Park, S.B., Choi, J.Y., Lee, E.J. et al. Diagnostic Criteria on 18F-FDG PET/CT for Differentiating Benign from Malignant Focal Hypermetabolic Lesions of Parotid Gland. Nucl Med Mol Imaging 46, 95–101 (2012). https://doi.org/10.1007/s13139-012-0135-y

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  • DOI: https://doi.org/10.1007/s13139-012-0135-y

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